JAN RICHARD GROENEWOLD Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051032264

License Status

INACTIVE

Business

First Name

JAN RICHARD

Last Name

GROENEWOLD

Business Name

JAN RICHARD GROENEWOLD

Original Issue Date

08/17/1978

Effective Date

03/31/2004

Expiration Date

03/31/2006

City

MANTENO

State

Zip

60950

County

KANKAKEE

Ever Disciplined

LastModifiedDate

01/18/2006